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Hepatic metabisulfite sensitivity in a patient with sclerosing cholangitis.

AbstractBACKGROUND:
Primary sclerosing cholangitis is an uncommon chronic cholestatic liver disease with a poor prognosis in symptomatic cases. Genetic and immunologic alterations have been identified, and many possible etiologies have been entertained. Most treatments have limited benefit, and primary sclerosing cholangitis is a common cause for liver transplantation.
OBJECTIVE:
To describe a patient with documented primary sclerosing cholangitis associated with chronic ulcerative colitis, who developed hepatic toxicity following ingestion of metabisulfite.
RESULTS:
A placebo-controlled oral challenge suggested metabisulfite hypersensitivity with liver toxicity. He was treated with cobalamin (to prevent sulfite toxicity), low-sulfite diet, steroids, and antibiotics and has had an unusually benign course for 19 years.
CONCLUSIONS:
The hypersensitivity to oral metabisulfite in our patient appeared to be a significant trigger to flare-ups of his disease. Controlling the response to metabisulfite (along with recurrent antibiotic and steroid therapy) may have contributed significantly to the remarkably good outcome in this patient.
AuthorsJames M Stormont, Morgan Flaherty, John Condemi
JournalAnnals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (Ann Allergy Asthma Immunol) Vol. 91 Issue 3 Pg. 314-7 (Sep 2003) ISSN: 1081-1206 [Print] United States
PMID14533666 (Publication Type: Comparative Study, Journal Article)
Chemical References
  • Placebos
  • Sulfites
  • metabisulfite
  • Alanine Transaminase
  • Alkaline Phosphatase
  • Vitamin B 12
Topics
  • Administration, Oral
  • Alanine Transaminase (blood)
  • Alkaline Phosphatase (blood)
  • Cholangitis, Sclerosing (etiology, therapy)
  • Diet Therapy
  • Hepatitis (blood, complications)
  • Humans
  • Liver (metabolism)
  • Male
  • Middle Aged
  • Placebos
  • Sulfites (administration & dosage, toxicity)
  • Vitamin B 12 (administration & dosage, therapeutic use)

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